AB1362 LOCATION AND NUMBER OF SARCOIDOSIS GRANULOMA, A POSSIBLE DIAGNOSTIC ARGUMENT?
Authors: O. Dhrif, M. S. Hamdi, I. Kechaou, I. Boukhris, E. Cherif, S. Azzabi, L. Ben Hassine
Journal: Annals of the Rheumatic Diseases (2022)

Background Sarcoidosis is a non-necrotizing granulomatous disease which diagnosis is often challenging and requires elimination of other causes of granulomatous lesions. Location and number of granulomatous lesions in patients are not yet established as arguments in diagnosing this disease. Objectives We therefor conducted a study aiming to compare locations and number of granulomas between patients with sarcoidosis and patients with other granulomatous diseases (OGD). Methods Cross sectional study in which were included patients in whom non-necrotizing granulomatous lesions have been identified via biopsy over a period of 11 years (2010 to 2021) then were stratified into two groups: sarcoidosis group and OGD group. Categorical variables were compared with the χ2 –test or Fisher’s test. Comparisons of the differences of continuous variables were performed by the Mann–Whitney U test or Student’s t-test. Pearson correlation ratio was used for linear correlation analysis. Results 30 patients were included in the sarcoidosis group and 32 in the OGD group. Aetiologies in the OGD group were: 10 tuberculosis cases, 5 lymphoma cases, 4 Primary biliary cholangitis cases, 1 Castleman’s disease and 12 idiopathic granulomas. Mean age was respectively in both groups 51+/-13 versus 57+/-17 years old (p=0.128), sex ratio (F/M) was 29/1 versus 27/5 (p=0.197). Associated signs were distributed in both groups as followed: 11(37%) versus 5(16%) general signs (p=0.085), 15(50%) versus 20(63%) lymphadenopathy (p=0.442), 4(13%) versus 6(19%) inflammatory arthralgias (p=0.733), 13(43%) versus 2(6%) cutaneous lesions (p=0.001), 4 versus no ocular manifestations (p=0.049), 20 (66%) versus 3(9%) pulmonary manifestations (p&lt;0.001), 5 (17%) versus 10 (31%) abdominal manifestations (p=0.239). Cutaneous, salivary gland and ENT granulomas were significantly more frequent in patients with sarcoidosis with respectively 11(37%) versus 1 (3%) (12.3 risk ratio 95%CI 10.4 to 14.4)(p=0.001), 8 (27%) versus 0% (p=0.002), 8(27%) versus 2(6%) (4.5 risk ratio 95% CI 3.1 to 5.9)(p=0.025). Lymph node, hepatic and pulmonary granulomas prevalence was not significantly higher in sarcoidosis patients, 17 (57%) versus 24 (75%) (p=0.180), 2 (7%) versus 5 (16%)(p=0.427), 3(10%) versus 0%(p=0.308). Mean number of granulomas found in one patient was significantly higher in sarcoidosis patients with 1.7 (95% CI 1.5 to 2) versus 1.1 (95%CI 1 to 1.2) (p=0.001). There was also a significant correlation between the number of granulomas in one patient and the angiotensin converting enzyme titres (r=0.566, 95% CI 0.360 to 0.771); (p=004). Conclusion This study shows that sarcoidosis patients have more often granulomas in the skin, salivary gland and ENT regions, and that the number of granulomas is on average superior in sarcoidosis than in OGD, these findings could be considered when establishing future diagnostic algorithms, as taking into account these elements could ease this diagnostic challenge in clinical practice. Disclosure of Interests None declared